Signs of a Miscarriage
Did you know that miscarriage is the most common pregnancy complication? If not - that's not on you! Miscarriage isn't commonly talked about. But once a woman experiences it, she begins to realize (thanks to stats and Google), that she's not alone. Miscarriages occur in 15-20% of pregnancies, and most commonly occur within the first 8 weeks of pregnancy. After 8 weeks, rates decline to about 3%. Another truth is that miscarriage is no one's fault - and once it's happening, there's often nothing that you can do to stop it.
Causes of Miscarriage
Miscarriage can happen for a variety of reasons including: factors associated with baby, factors associated with mom, factors associated with dad, chromosomal abnormalities, age, environmental exposure, hormonal disorders, immune factors, coagulation disorders and nutritional deficiencies.
Signs and Symptoms
The most common sign associated with miscarriage is vaginal bleeding. Bleeding at any point during pregnancy can indicate serious problems. Bleeding may be accompanied by the passing of clots, tissue or a gush of fluid. There may be cervical dilation. Abdominal cramping, pain or contractions may also occur and become regular. Lastly, you may notice diminishing signs of pregnancy such as nausea and vomiting and breast tenderness. Depending on the type of miscarriage you are experiencing, a pregnancy test may reveal a negative result.
Diagnosis
Unfortunately, you can't self-diagnose a miscarriage. You may see the signs and symptoms that are occurring, but diagnosis depends on an ultrasound and determining if there's cervical dilation.
Types of Miscarriage & Treatment
Threatened Miscarriage
This occurs when a woman notices vaginal bleeding within the first 20 weeks of pregnancy. She may also experience backache, abdominal aching or cramping. The cervix will appear closed upon vaginal inspection. The fetal heartbeat may be found via the ultrasound. Essentially, we treat this as a viable baby until we're concerned that there's no heartbeat.
Medical Treatment: Watch and wait, bed rest, possibly supplementing with progesterone and administering uterine muscle relaxants.
Naturopathic Treatment: Watch and wait, assessing for stress, dehydration and malnutrition. UTIs should also be ruled out. Acupuncture may help to harmonize the different pathways in the body. In TCM terms, this is considered a kidney yang deficiency, and the uterus must be kept warm (think of warm foods, heat over the abdomen, stimulating the appropriate acupuncture points, etc.) Botanicals may also be introduced such as Viburnum opulus (Crampbark) and Dioscorea villosa (Wild Yam) as they are both uterine antispasmodics.
Inevitable Miscarriage
Presentation of bleeding which may range between minimal to severe, along with some lower abdominal cramping. The cervix appears dilated. At this point, treatment should not include strategies to help prevent miscarriage. Diagnosis will depend on ultrasound.
Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, dilation and evacuation to empty the uterus.
Naturopathic Treatment: Emotional support, addressing blood loss, physiological and psychological stress. Supporting the menstrual cycle.
Incomplete Miscarriage
Includes vaginal bleeding, contractions, cervical dilation and incomplete passage of conception products. Sadly, the baby has passed on or is part of the tissue that has yet to pass. Both methods of treatment will support emotional and physical wellbeing of the mother and partner.
Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, dilation and evacuation to empty the uterus.
Complete Miscarriage
All uterine contents of the pregnancy are passed. Cramping and abdominal pain may subside shortly after. The cervix will return to an undilated state, and a pregnancy test will read as negative. Both treatments will support emotional and physical wellbeing of the mother and partner.
Missed Miscarriage
Unfortunately the baby has passed, but is still present in the uterus with no signs of miscarriage. This may continue for a few weeks before a miscarriage occurs, or it may be found at a routine checkup. Because it may lead to a serious maternal infection, medical care must be obtained.
Medical Treatment: Confirmation by ultrasound, and evacuation of the products of conception.
Naturopathic Treatment: Emotional support, regulation of the menstrual cycle.
Recurrent Miscarriage
'Recurrent' is diagnosed if there is a history of 3 or more pregnancy losses. At this point, it's advices that both partners undergo genetic testing to determine a possible cause of miscarriage. Moreover, the couple may need undergoing care if a chronic problem presents. Typically hormonal causes are the most prevalent and may involve the ovary, placenta or thyroid. Diseases also involved with recurrent miscarriage include: hypothyroidism, hyperthyroidism, PCOS, type 2 diabetes, gynecological disease (ie. endometriosis) and intestinal disorders (ie. IBS). It's recommended that couples stop trying for about 3-6 cycles - to determine a cause and seek treatment for it.
Medical Treatment: Determine a cause, chromosomal evaluation of both parents.
Naturopathic Treatment: Determine a cause, prevent future miscarriages, supplement with a botanical like Vitex agnus-castus (Chaste Tree) if there is an issue with HPA axis and progesterone. In TCM terms kidney yin deficiency is the most common cause of recurrent miscarriages - this means that the uterine environment is hot and dry, the endometrial lining may not be thick enough to accept an embryo.
Next Steps
It's evident with many of the types of miscarriage - there's nothing you can do to prevent them. That said if you've experienced a miscarriage, it's best to wait a couple of menstrual cycles before trying again. For couples experiencing recurrent miscarriages - there is a lot that you can do to support your health before trying again. Now is a great time to look at your diet and lifestyle and work with a Naturopathic Doctor to make fundamental changes to support a healthy pregnancy. Moreover, if you are looking to supplement with herbs or vitamins - get an expert to assess them and educate you on what to look for and how to choose a product. Just because something is on sale or is the second cheapest one (you're not choosing a bottle of wine here!) doesn't mean it's going to be high quality or even the right dose that you need.
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Supportive Resources
Sunnybrook Resources for Grieving Parents - They have compiled a huge database of web resources and chat rooms. This site is definitely worth a visit.